Brain injuries may affect women worse than men – introduction of concussion spotters to Women’s World Cup could prove vital


The matches at the 2023 Fifa Women’s World Cup will be watched by concussion spotters for the first time. These medical staff will attempt to identify potential concussions that may have been overlooked by the officials on the pitch.

The role of the concussion spotter may be particularly vital in the women’s game because there is evidence that concussion has a worse impact on women.

Their use at the Women’s World Cup comes after a similar trial at the men’s competition in Qatar in 2022. However, while those in the men’s game were present at the stadium, in this tournament concussion spotters will work remotely, watching incidents on a screen, which may have an impact on their effectiveness.

A concussion is a traumatic brain injury that affects your brain function. Immediately after the injury, concussion can lead to dizziness, confusion, and vomiting, but it is important to remember that sometimes there may be no initial symptoms. Losing consciousness only happens in about 10% of conscussions.

Concussion can have longer-term effects, too. Research suggests that repeated concussions can lead to poorer mental health and that repeated head injuries can result in degenerative brain diseases.

My own research has found that people who had experienced a concussion struggled with switching between tasks more than people with no history of concussion. Task switching is important for daily life as well as in sport – it allows us to quickly adapt to different situations.

Concussion in women

What’s more, research has found that women reported more concussion symptoms than men. Some studies suggest that it takes women longer to recover.

A large-scale study of teenage footballers found that concussion was almost twice as likely in girls than their male counterparts. The research also found that boys were over one and a half times more likely to be removed from play immediately.

In American football, the National Football League (NFL) introduced ATC (athletic trainer certified) spotters in 2012. Their primary job is to alert the sideline medical staff of potential concussion. The NFL spotters are independent to ensure they prioritise the players’ health over the team’s fortunes. They cannot cover a game if they have worked full-time in the past for a team involved, and they must not have been employed by an NFL team in the past five years.

A 2019 report found that the use of ATC spotters improved the real-time detection of concussed players in the NFL.

Power to the spotters

Since 2015, ATC spotters have the ability to stop the game with a medical time-out. This can be enforced if there is clear visual evidence that a player is obviously disorientated, or if a player is trying to stay in the game and not receive medical attention.

The importance of this became clear when, on just the second day of the 2022 men’s World Cup, an incident showed that, even with the concussion spotter system in place, team staff were allowing injured players to continue.

Iranian goalkeeper Alireza Beiranvand collided with his teammate, ultimately leading to his withdrawal from a group match against England. But first, the Iran coaching staff allowed the player the opportunity to carry on playing. Beiranvand fell over when attempting a goal kick – at which point he was finally deemed unable to continue.

Medical staff carrying man on stretcher off football pitch
Alizera Beiranvand of Iran is stretchered off during a 2022 FIFA Men’s World Cup match.
David Klein/Sportimage/Alamy Live News

Having independent medical staff is imperative given the pressures that club doctors are sometimes under to let a footballer play on. FIFA’s medical director Andrew Massey has spoken out about how difficult it is for club medics to make a decision to remove a player with a possible concussion.

In 2019, Massey was part of Liverpool FC’s medical staff when star player Mohamed Salah sustained a heavy blow to both head and body and was substituted. Liverpool were fighting for the Premier League title and given Salah’s importance to the team, Massey has admitted to the possible consequences of the substitution being in his mind.

Increased efforts to develop concussion protocols in the game is a positive step. We are increasingly learning about the significant effects of head injuries in sport, and the focus on the issue at major tournaments will help widen this understanding. The spotters will be discussed in commentary and broadcasts around the world.

This increased exposure should help alleviate poor attitudes towards concussion in sport. Although the current power of concussion spotters may be debatable, it is a step in the right direction.

As the tournament commences, the concussion spotters will have a keen eye on the players – but many people, like me, will be paying attention to the spotters, too.



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